Having Difficult Conversations: The Advanced Practitioner’s Role

Svarovsky, Therese

doi:10.6004/jadpro.2013.4.1.5

Cited by 5 publications

(5 citation statements)

References 16 publications

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“…Therefore, much of phase II centers on using empathetic communication techniques, specifically assessing resident and/or surrogates' knowledge of their illness and its trajectory, responding to emotions, and empathetic ways to elicit values and goals that guide treatment choices (Back et al, 2019). Specifically, trainees are taught to use three communication approaches: ask-tell-ask, SPIKES [setting, perception, invitation, knowledge, emotion, summarize, and REMAP [reframe, expect emotion, map values, align, propose a plan) (National Center for Ethics in Health Care, 2019; Svarovsky, 2013). During the workshop, emphasis is placed on revisiting goals of care conversations with the patient and their family as well as the interdisciplinary team throughout the trajectory of a serious illness.…”

Section: Methodsmentioning

confidence: 99%

Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care

Carpenter

Ersek

2021

J Am Assoc Nurse Pract

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Current palliative care workforce projections indicate that the growing palliative care needs of older adults in US nursing homes cannot be met by specialists, leaving them vulnerable and at risk for poor end-of-life outcomes. The purpose of this article is to describe the development, implementation, and initial evaluation of a program to support primary care nursing home nurse practitioners (NPs) in palliative care. The program aimed to improve geriatric NPs' knowledge and skills related to palliative care and to provide a structured protocol for integrating palliative care encounters into NPs' practice. It comprised three phases consisting of asynchronous online learning modules, a 1-day face-to-face communication skills and patient simulation workshop, and ongoing monthly virtual meetings to support NP clinical practice. Over a 1-year period, the program was developed and implemented with 12 practicing NPs in a national organization. Through an online survey and face-to-face feedback, NPs reported satisfaction with the curriculum and expressed it as valuable to their clinical practice. Future work will focus on sustaining implementation of the program, measuring patient level outcomes, and refining the curriculum based on NP feedback.

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Section: Methodsmentioning

confidence: 99%

Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care

Carpenter

Ersek

2021

J Am Assoc Nurse Pract

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“…Prior literature has found evidence of differences in practice styles between APCs and physicians 44,45 : Patients who received care from APCs had longer patient visits and received more educational services 46 . Nurse practitioners are trained to practice in a framework of interprofessional collaboration and patient‐centered holistic nursing care, 47 including leading difficult conversations across the life continuum 48 . Increasingly, physician assistants have been taking on roles in palliative care, and continuing education opportunities are available for them to gain specialized palliative care knowledge 49 .…”

Section: Discussionmentioning

confidence: 99%

“…46 Nurse practitioners are trained to practice in a framework of interprofessional collaboration and patient-centered holistic nursing care, 47 including leading difficult conversations across the life continuum. 48 Increasingly, physician assistants have been taking on roles in palliative care, and continuing education opportunities are available for them to gain specialized palliative care knowledge. 49 Future research should identify the specific mechanisms driving these favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Advanced practice clinician care and end‐of‐life outcomes for community‐ and nursing home‐dwelling Medicare beneficiaries with dementia

White

Muench

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONOlder adults with Alzheimer's disease and related dementias (ADRD) often face burdensome end‐of‐life care transfers. Advanced practice clinicians (APCs)—which include nurse practitioners and physician assistants—increasingly provide primary care to this population. To fill current gaps in the literature, we measured the association between APC involvement in end‐of‐life care versus hospice utilization and hospitalization for older adults with ADRD.METHODSUsing Medicare data, we identified nursing home‐ (N=517,490) and community‐dwelling (N=322,461) beneficiaries with ADRD who died between 2016 and 2018. We employed propensity score‐weighted regression methods to examine the association between different levels of APC care during their final 9 months of life versus hospice utilization and hospitalization during their final month.RESULTSFor both nursing home‐ and community‐dwelling beneficiaries, higher APC care involvement associated with lower hospitalization rates and higher hospice rates.DISCUSSIONAPCs are an important group of providers delivering end‐of‐life primary care to individuals with ADRD.HIGHLIGHTS For both nursing home‐ and community‐dwelling Medicare beneficiaries with ADRD, adjusted hospitalization rates were lower and hospice rates were higher for individuals with higher proportions of APC care involvement during their final 9 months of life. Associations between APC care involvement and both adjusted hospitalization rates and adjusted hospice rates persisted when accounting for primary care visit volume.

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“…One way of improving patient satisfaction is by viewing the patient as the center of care-an important stakeholder and a collaborator in good health outcomes with the right to make important decisions about the services rendered based on an informed understanding of their condition, treatment options and possible environmental setting for conducting healthcare discussions, evaluating the patient's understanding of the disease and anticipated prognosis, obtaining an invitation to provide further information, addressing any emotion portrayed, and an opportunity to summarize the discussion points (11,12). The Ask-Tell-Ask approach allows the healthcare practitioner to establish the patients and care-givers' perception on the diagnosis made, provide them information, and establish the level of understanding (13).…”

Section: Introductionmentioning

confidence: 99%

“…The strategy used for patient-centered communication during the intervention was the SPIKES protocol that involves setting up the scene for the discussion; establishing the patients perception of their medical condition; obtaining and invitation to start a discussion; sharing knowledge with the patient and empathetically addressing emotion; and finally summarizing the discussion and strategizing or planning next steps (12).…”

Section: Introductionmentioning

confidence: 99%

Impact of patient-centered communication on patient satisfaction scores in patients with chronic life-limiting illnesses: an experience from Kenya

Sirera,

Naanyu,

Kussin

et al. 2024

Front. Med.

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BackgroundPatient satisfaction remains a key area of interest worldwide; utilizing a patient-centered communication approach, particularly with patients with chronic life-limiting illnesses may be one way to achieve this. However, there is a dearth of empirical information on the effect of patient-centered communication strategies in patients with chronic life-limiting illnesses in Kenya on patient satisfaction.ObjectivesThe objective of this study was to assess the impact of patient-centered communication on patient satisfaction.MethodsWe conducted our study at a tertiary teaching and referral hospital in Kenya. We utilized a quasi-experimental pre-test post-test study design and engaged 301 adult medical in-patients with chronic life limiting conditions. We randomized them to receive patient-centered communication, and evaluated the change in patient satisfaction scores using an adapted Medical Interview satisfaction Scale 21 (MISS 21).ResultsTwo hundred and seventy-eight out of 301 recruited participants completed the study. The baseline characteristics of the participants randomized to the control and intervention arms were similar. Although both the control and intervention arms had a decline in the mean difference scores, the intervention arm recorded a larger decline, −15.04 (−20.6, −9.47) compared to −7.87 (−13.63, −2.12), with a statistically significant mean difference between the two groups at −7.16 (−9.67, −4.46). Participants in the intervention arm were less likely to: understand the cause of their illness (p < 0.001), understand aspects of their illness (p < 0.001), understand the management plan (p < 0.001), receive all the relevant information on their health (p < 0.001), and to receive adequate self-care information (p < 0.001). They were also less likely to acknowledge a good interpersonal relationship with the healthcare providers (p < 0.001), to feel comfortable discussing private issues (p < 0.004), and to feel that the consultation time was adequate (p < 0.001).Conclusion and recommendationContrary to expectation, patient-centered communication did not result in improved patient satisfaction scores. Further studies can evaluate factors affecting and explaining this relationship and assess intermediate and long-term effects of provision of a patient-centered communication in diverse global contexts.

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Having Difficult Conversations: The Advanced Practitioner’s Role

Cited by 5 publications

References 16 publications

Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care

Developing and implementing a novel program to prepare nursing home-based geriatric nurse practitioners in primary palliative care

Advanced practice clinician care and end‐of‐life outcomes for community‐ and nursing home‐dwelling Medicare beneficiaries with dementia

Impact of patient-centered communication on patient satisfaction scores in patients with chronic life-limiting illnesses: an experience from Kenya

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